Recent Scientific Abstracts of Tattoo Removal

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Tattoo removal–state of the art. Pfirrmann G, Karsai S, Roos S, Hammes S, Raulin C. J Dtsch Dermatol Ges. 2007 Oct;5(10):889-97.

Tattooing has been around since the early beginnings of modern civilization. The
discovery of selective photothermolysis at last has made it possible to remove
tattoos without leaving a scar. Q-switched neodymium: yttrium-aluminum-garnet,
alexandrite, and ruby lasers with pulse durations in the nanosecond domain
fulfill this need. Argon or cw-CO(2) lasers as well as intense pulsed light
sources should not be used since they often produce significant scarring. This
article provides an overview of current laser systems. Developments leading to
new tattoo inks, feedback systems to detect the absorbance characteristics of
tattoo inks, dermal clearing agents, and perhaps even lasers with shorter
pulse-durations might improve the results in the future.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Tattoo removal. Burris K, Kim K. Clin Dermatol. 2007 Jul-Aug;25(4):388-92.

Tattoos have been a part of costume, expression, and identification in various
cultures for centuries. Although tattoos have become more popular in western
culture, many people regret their tattoos in later years. In this situation, it
is important to be aware of the mechanisms of tattoo removal methods available,
as well as their potential short- and long-term effects. Among the myriad of
options available, laser tattoo removal is the current treatment of choice, given
its safety and efficacy.

Cosmetic and reconstructive medical tattooing. Setlur J. Curr Opin Otolaryngol Head Neck Surg. 2007 Aug;15(4):253-7.

PURPOSE OF REVIEW: Tattooing or dermatography for cosmetic and reconstructive
purposes continues to grow in popularity because of its ability to easily alter
appearance. Though licensed professionals perform some procedures, amateurs
lacking formal training still place many tattoos. There is a multitude of
unforeseen complications resulting from tattooing, which have been detailed in
the medical literature for a number of years. Despite awareness of adverse
reactions, there is a lack of basic science research with respect to tattooing.
Medical practitioners are faced with diagnosing and treating complications of
tattooing. A review of recent tattooing literature is useful, although most of it
exists as case reports. RECENT FINDINGS: Recent findings focus on the adverse
outcomes of tattooing and their management. Methods of tattoo removal and
resultant complications along with patient disease resulting from tattoo
placement continue to be well published topics. SUMMARY: A review of the recent
literature pertaining to cosmetic and reconstructive tattooing results in an
emphasis on complications and management. Despite the number of published case
reports detailing the adverse outcomes of tattoos, there continues to be a lack
of fundamental research about the topic.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

The art of tattooing and the science of tattoo removal. Holman J, Edison K. Mo Med. 2007 Mar-Apr;104(2):149-50, 152-4; discussion 151.

In recent years there has been a dramatic increase in body tattooing among all
socioeconomic groups. This paper describes the techniques of tattooing, the
public health implications, methods for removal of tattoos.

Treatment modalities for allergic reactions in pigmented tattoos. [Article in English, German] Zwad J, Jakob A, Gross C, Rompel R. J Dtsch Dermatol Ges. 2007 Jan;5(1):8-13.

Decorative tattoos have become very popular. As a result, a higher number of
hypersensitivity reactions are seen, caused by the mostly undeclared tattoo dyes.
If local and intralesional therapy with corticosteroids is not effective, total
excision was formerly considered the best approach. Selective laser therapy
offers an alternative approach for removing the offending pigment. Case reports
are used to illustrate the individual treatment options for removal of tattoos.

Tattoos: a review of tattoo practices and potential treatment options for removal. Sweeney SM. Curr Opin Pediatr. 2006 Aug;18(4):391-5.

PURPOSE OF REVIEW: The purpose of this review is to present an overview of tattoo
practices, complications and treatment options relevant to the pediatric
population. RECENT FINDINGS: Tattoos are popular among adolescents for a variety
of reasons and may be associated with other high-risk behaviors. Research
indicates that adolescents may not comprehend potential health risks and
complications that are related to tattooing. Case reports of infection,
tattoo-associated dermatoses, and allergic reactions to tattoos continue to be
reported in the literature. Additional cases of allergic contact dermatitis are
being reported with temporary henna tattooing and cosmetic tattoos. As the desire
for tattoo removal increases, researchers continue to explore safe, innovative
and efficacious methods of tattoo removal. SUMMARY: As the popularity of
tattooing continues to rise, so do the potential complications and adverse
effects. Treatment options for tattoos are well described and must be
individualized to each patient. Lasers continue to be a reliable and efficacious
tool in treating amateur, professional, cosmetic and traumatic tattoos.

Adverse events associated with nonablative cutaneous visible and infrared laser treatment. Handley JM. J Am Acad Dermatol. 2006 Sep;55(3):482-9.

Since the theory of selective thermolysis was developed in the early 1980s, there
have been numerous advances in both laser technology and the understanding of
laser-tissue interaction. Nonablative dermatologic treatments involving laser
light continue to be increasingly used for a number of diverse applications such
as skin remodeling, the treatment of cutaneous melanocytic and vascular lesions,
and the removal of undesired hair and tattoo pigment. Although these techniques
are regarded as safe, both temporary and permanent adverse reactions do occur,
many of which are thermally mediated. Little has been published on the frequency
of adverse events in nonablative cutaneous laser treatments, or on the
comparative efficacy of the various strategies commonly used to minimize them.
Through reviewing relevant publications from the last 5 years, this article will
address both these issues.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

The use of lasers for decorative tattoo removal. Mariwalla K, Dover JS. Skin Therapy Lett. 2006 Jun;11(5):8-11.

As the incidence of tattoo placement continues to increase, so does the demand
for tattoo removal, with more than 10 million people in the US alone with a
tattoo. Used in an appropriate clinical setting, Q-switched lasers provide
relatively efficacious clearance of decorative tattoo pigment with minimal
side-effects. We present our clinical experience along with literature findings
on decorative tattoo removal and the important issues practitioners should
consider in the management of tattoos.

Laser treatment of tattoos. Bernstein EF. Clin Dermatol. 2006 Jan-Feb;24(1):43-55.

Tattooing has been around since the early beginnings of modern civilization.
Modern tattoo artists use a myriad of colors to produce striking designs,
resulting in permanent works of body art; however, we humans have been changing
our minds since the beginning of time. Our fickle nature results in the desire to
change what has been placed as a permanent reminder of a friend, spouse, or work
of art. Removing tattoos began with abrasive and destructive measures to destroy
the tattoo, and unfortunately, the skin it was contained in. The discovery of
selective photothermolysis, the ability to selectively remove target structures
without disrupting the surrounding skin, made it at least possible to remove
tattoos without destroying the surrounding skin leaving a scar. Theory predicted
that pulse durations in the nanosecond domain would be optimal for tattoo
removal, and the Q-switched neodymium:yttrium-aluminum-garnet, alexandrite, and
ruby lasers fulfilled this need. Too often, older lasers or intense pulsed light
sources are used to treat tattoos, often with significant scarring. Since the
advent of the Q-switched lasers more than a decade ago, improvement in
tattoo-removal lasers has been incremental. Developments leading to new tattoo
inks, feedback systems to detect the absorbance characteristics of tattoo inks,
dermal clearing agents, and perhaps even shorter pulse-duration lasers should
result in improved results for the future.

Cosmetic and reconstructive medical tattooing. van der Velden EM, Defranq J, Baruchin AM. Curr Opin Otolaryngol Head Neck Surg. 2005 Dec;13(6):349-53.

PURPOSE OF REVIEW: Cosmetic and reconstructive medical tattooing techniques are
being used with a higher frequency than ever before. The volume of scientific
research into its basics, however, is too small to prevent the present occurrence
of complications. This review shows that most of the recent articles on the
subject are in fact case reports and that many of the complications described
result from the failure to conduct more research. RECENT FINDINGS: Recent
findings include few and relatively unimportant new techniques, studies
describing tattoo removal with laser, magnetic displacement and chemical
irritants, more findings about infections and allergies, and complications with
high field-strength magnetic resonance imaging scans. SUMMARY: Recent literature
contains very few useful studies because generally they are not supported by
sufficient scientific research.

Cicatricial eyebrow reconstruction with a dense-packing one- to two-hair grafting technique. Wang J, Fan J. Plast Reconstr Surg. 2004 Nov;114(6):1420-6.

Scarring eyebrow loss is usually repaired with a hair-bearing island scalp flap
or scalp strip grafting technique. The results, however, are usually not
desirable with regard to appearance. In this article, a one- or two-hair graft
with a dense-packing technique was developed for cicatricial eyebrow
reconstruction. It was carried out by harvesting a scalp strip close to the
hairline of the back, then dividing it into a series of one- or two-hair grafts,
and finally implanting the grafts into the prepared recipient holes of the
eyebrow with a desired hair direction. With the authors’ experience in treating
96 patients (154 eyebrows) in cases of burn, skin grafting, traumatic scarring,
and chemical peeling scar after tattoo removal, the eyebrows could be restored in
only one session. In general, 150 to 200 grafts with 200 to 250 hairs were needed
for a complete male eyebrow reconstruction and 100 to 150 grafts with 150 to 200
hairs were needed for a complete female eyebrow reconstruction. The maximal hair
density was 91.5 hairs/cm per session. Over a 6-month follow-up period, the mean
graft survival rate reached 98.1 percent. All of the patients achieved
satisfactory results, with a very natural appearance. These results indicate that
the above-mentioned technique could be a practical, effective, and probably ideal
method for cicatricial eyebrow reconstruction.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Novel dermatologic uses of the immune response modifier imiquimod 5% cream. Berman B, Poochareon VN, Villa AM. Skin Therapy Lett. 2002 Nov;7(9):1-6.

Imiquimod is the first of a new class of drugs to emerge in the treatment of
various dermatologic disorders. As an immune response modifier, it has been shown
to have potent antiviral and antitumor properties through the stimulation of
innate and cell mediated immune pathways. It is currently approved for the
treatment of external genital and perianal warts, but has also been found to be
an effective treatment for a host of other virus-associated dermatologic lesions,
including common and flat warts, molluscum contagiosum and herpes simples 2.
Oncological lesions showing improvement with the use of imiquimod include basal
cell carcinoma, actinic keratosis, squamous cell carcinoma in situ, malignant
melanoma, cutaneous T-cell lymphoma, and cutaneous extramammary Paget’s disease.
Recent case studies have also found this product to be effective for treating
keloids, infantile hemangiomas, porokeratosis of Mibelli, leishmanisis, and
tattoo removal. This extensive array of disorders treated successfully with
imiquimod warrants further study of this novel and valuable drug.

Tattoo-associated dermatoses: a case report and review of the literature. Jacob CI. Dermatol Surg. 2002 Oct;28(10):962-5.

BACKGROUND: Tattoos are increasingly popular in today’s society, especially with
the advent of laser tattoo removal. As a result, observed reactions within
tattoos are likely to become more abundant. Three main classes of
tattoo-associated dermopathies can be distinguished in the English literature:
allergic/granulomatous/lichenoid, inoculation/infection, and coincidental
lesions. Injury to the dermis, such as during placement of a tattoo, can also
flare a Koebner response in patients with active susceptible disease. OBJECTIVE:
This case report and review of the English literature provides a quick reference
to tattoo reactions, techniques available for removal of tattoos, and disorders
other than tattoos known to exhibit the Koebner response. METHODS: The English
literature was reviewed via MEDLINE citations from 1966 to December 2001 to
delineate articles involving tattoo reactions and Koebner reactions significant
to dermatology. CONCLUSION: Numerous conditions have been documented in
association with tattoos and the process of tattoo application. Awareness and
identification of dermatoses associated with tattoos, tattoo removal options, and
conditions associated with the Koebner response are important to both the
dermatologist and dermatologic surgeon.

Immediate cutaneous hypersensitivity after treatment of tattoo with Nd:YAG laser: a case report and review of the literature. England RW, Vogel P, Hagan L. Ann Allergy Asthma Immunol. 2002 Aug;89(2):215-7.

BACKGROUND: To our knowledge this is the first reported case of an immediate
cutaneous reaction to Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser
tattoo removal. A 26-year-old female presented with two 6-year-old tattoos placed
at different times. These were of different colors and had remained entirely
asymptomatic since placement. There was a Mardi Gras mask on her thigh and a
Tasmanian devil on her chest. With laser treatment of the Tasmanian devil, she
experienced no untoward effects. However, with treatment of the Mardi Gras mask
tattoo, she developed an extensive urticarial and indurated reaction 30 minutes
posttreatment. The identical reaction occurred twice with subsequent laser
treatments. Dermatology consulted allergy to provide prophylaxis against possible
systemic reaction with subsequent Nd:YAG laser therapy. The patient was treated
with 3 days of prednisone, cetirizine, and ranitidine before subsequent laser
treatments. Prophylactic treatment suppressed all subsequent reactions to laser
therapy. RESULTS: Delayed hypersensitivity to tattoo pigments occurring days to
weeks after placement is well documented. There are no previous reports of
immediate hypersensitivity during placement or laser removal. However, there are
two previous reports of local and systemic delayed reactions after laser therapy.
CONCLUSIONS: As far as we know, this is the first case report of immediate
hypersensitivity after Nd:YAG laser treatment of a tattoo. Prophylactic treatment
with steroids and antihistamines prevented reactions with subsequent laser
treatments. Reactions after laser removal are rare, but may increase as
popularity of skin art increases with the need for subsequent removal.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Laser removal of tattoos. Kuperman-Beade M, Levine VJ, Ashinoff R. Am J Clin Dermatol. 2001;2(1):21-5.

Tattoos are placed for different reasons. A technique for tattoo removal which
produces selective removal of each tattoo pigment, with minimal risk of scarring,
is needed. Nonspecific methods have a high incidence of scarring, textural, and
pigmentary alterations compared with the use of Q-switched lasers. With new
advances in Q-switched laser technology, tattoo removal can be achieved with
minimal risk of scarring and permanent pigmentary alteration. There are five
types of tattoos: amateur, professional, cosmetic, medicinal, and traumatic.
Amateur tattoos require less treatment sessions than professional multicolored
tattoos. Other factors to consider when evaluating tattoos for removal are:
location, age and the skin type of the patient. Treatment should begin by
obtaining a pre-operative history. Since treatment with the Q-switched lasers is
painful, use of a local injection with lidocaine or topical anaesthesia cream may
be used prior to laser treatment. Topical broad-spectrum antibacterial ointment
is applied immediately following the procedure. Three types of lasers are
currently used for tattoo removal: Q-switched ruby laser (694 nm), Q-switched
Nd:YAG laser (532 nm, 1064 nm), and Q-switched alexandrite laser (755 nm). The
Q-switched ruby and alexandrite lasers are useful for removing black, blue and
green pigments. The Q-switched 532 nm Nd:YAG laser can be used to remove red
pigments and the 1064 nm Nd:YAG laser is used for removal of black and blue
pigments. The most common adverse effects following laser tattoo treatment with
the Q-switched ruby laser include textural change, scarring, and pigmentary
alteration. Transient hypopigmentation and textural changes have been reported in
up to 50 and 12%, respectively, of patients treated with the Q-switched
alexandrite laser. Hyperpigmentation and textural changes are infrequent adverse
effects of the Q-switched Nd:YAG laser and the incidence of hypopigmentary
changes is much lower than with the ruby laser. The development of localized and
generalized allergic reactions is an unusual complication following tattoo
removal with the Q-switched ruby and Nd:YAG lasers. Since many wavelengths are
needed to treat multicolored tattoos, not one laser system can be used alone to
remove all the available inks and combination of inks. While laser tattoo removal
is not perfect, we have come a long way since the advent of Q-switched lasers.
Current research is focusing on newer picosecond lasers, which may be more
successful than the Q-switched lasers in the removal of the new vibrant tattoo

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Tattoos: counseling the adolescent. Montgomery DF, Parks D. J Pediatr Health Care. 2001 Jan-Feb;15(1):14-9.

In Western society, approximately 3% to 5% of the population has at least one
decorative tattoo, and the number of new tattoos has increased dramatically over
the last decade. Tattooing is becoming increasingly popular among adolescents.
Pediatric nurse practitioners (PNPs) are in key positions to counsel
preadolescents and adolescents about tattoos. PNPs should be knowledgeable about
the care, potential adverse reactions, risks of blood-borne diseases, and removal
of tattoos. PNPs should also have an understanding of who gets tattoos, why they
get tattoos, and what type of regulations exist related to tattooing in the
United States.

Treatment of gunpowder traumatic tattoo by Q-switched Nd:YAG laser: an unusual adverse effect. Fusade T, Toubel G, Grognard C, Mazer JM. Dermatol Surg. 2000 Nov;26(11):1057-9.

BACKGROUND: The Q-switched Nd:YAG laser can completely eliminate traumatic
tattoos. OBJECTIVE: We report the results of the unsuccessful removal of
traumatic tattoos among three patients with dermal inclusions of gunpowder who
were shot at close range. METHODS: Treatment was tried in each patient with a
Q-switched Nd:YAG laser at a medium fluence (4-6 J/cm2). RESULTS: During
treatment of our patients, each pulse provoked sparks and the immediate formation
of bleeding trans- epidermal pits. After the healing process was completed, we
observed poxlike scars and the spreading of pigments in the skin around the
initial points of the tattoo. CONCLUSION: We hypothesize that the rapid transfer
of high-energy pulses to powder particles creates microexplosions of these
fragments resulting in cavitation and provoking transepidermal holes and
subsequent scars. This adverse effect was only produced if the tattoo resulted
from gun powder being shot at a short distance from the skin.

Laser tattoo removal. Adrian RM, Griffin L. Clin Plast Surg. 2000 Apr;27(2):181-92.

The availability of Q-switched ruby Nd:YAG and alexandrite lasers has
revolutionized the treatment of tattoos. These modalities offer significant
advantages over all previously available treatments and are currently the
standard of care for the cosmetic removal of unwanted tattoos.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.

Laser treatment of tattoos. Kilmer SL. Dermatol Clin. 1997 Jul;15(3):409-17.

All three Q-switched laser systems can effectively remove most tattoos with
minimal scarring or other adverse sequelae. Despite advances in laser technology,
all tattoos cannot be completely eliminated, and several wavelengths remain
necessary to optimally treat multicolored tattoos. The major advantage of
Q-switched laser irradiation to effect tattoo removal is the low risk of scarring
associated with treatment. Limitations include the need for multiple treatment
sessions, minimal to incomplete responses in some cases, and the possibility of
pigmentary and textural changes. Research continues in an effort to perfect laser
removal of tattoos.

Lasers in aesthetic surgery. Rosenberg GJ, Gregory RO. Clin Plast Surg. 1996 Jan;23(1):29-48.

Lasers are now in their third decade of medical application. The use for
aesthetic surgery is relative new. Multiple attempts to use lasers in cosmetic
surgery, in the past, resulted in less than desirable results. The current
generation of lasers now has multiple applications in aesthetic surgery, with
much success in tattoo removal, skin resurfacing, and cosmetic procedures. The
plastic surgeon, with an augmented armamentarium, is now able to solve old
problems and face new challenges. Careful attention to the fine details will
allow the surgeon to avoid problems and complications when using the laser for
aesthetic surgery. The ease of using the laser, speed of the procedure, patient
satisfaction, and the minimal amount of potential complications all encourage the
plastic surgeon to utilize the laser for aesthetic surgery.

Lasers in oculoplastic surgery. Maus M. Curr Opin Ophthalmol. 1995 Oct;6(5):37-42.

Applications of laser-assisted surgery in oculoplastics are varied because the
enormous scope of the specialty overlaps with ear, nose and throat, dermatology,
plastic surgery, and ophthalmology, for example. All of these specialties have
applications for lasers that in one fashion or another find their way into our
armamentarium. In this article we present the last year’s advances in laser
applications in oculoplastics. By far, endonasal dacryocystorhinostomies are the
most controversial and interest producing. Several articles address different
approaches and conclusions. No final determination is available yet as to the
effectiveness and ultimate success of this procedure. Dermatologic surgery for
lesion removal and for cosmetic surgery also features in this year’s review. The
use of lasers for tattoo removal was reported in detail in a superb article.
Overall there were no major breakthroughs in laser surgery, however, several
well-thought-out articles have added to our understanding of this surgical

Tattoo removal. Goldstein N. Dermatol Clin. 1987 Apr;5(2):349-58.

The reasons for tattoo removal can be personal, social, cultural, and medical.
Removal methods have been many and varied, and all of the past methods are
summarized. Details of modern tattoo removal methods by physicians, ranging from
dermabrasion to laser therapy, are described. Included are descriptions of
excision and closure techniques, and split-thickness tangential excision.

Updates from New York Offices: Fresh Meadows, Roslyn, Commack, West Islip, East Setauket and New Jercy Office at Ridgewood. These Scientific studiea are provided for Informational Purpose Only.